Insulin Infusion Preparation and Management

Recommended Practices

The Anaesthesia society recommends that sodium chloride 0.9%, with or without heparin, should be the only solution used for arterial line infusion and flushing to prevent sample contamination errors 1, 2
Hospitals must have policies that define local procedures for arterial line use, including prescribing, administering, and monitoring flush solutions, as recommended by the Anaesthesia society 2
The flush solution must be independently double-checked by a second practitioner before setting up and attaching to an arterial line, according to the Anaesthesia society guidelines 3
All staff involved in the insertion, management, or sampling from arterial lines must be appropriately trained to prevent sample contamination errors, as emphasized by the Anaesthesia society 2

Using glucose-containing solutions as insulin diluents can lead to dangerous sampling errors when monitoring blood glucose levels, as noted by the Anaesthesia society 1
Even minimal contamination of blood samples with glucose-containing solutions can conceal true hypoglycemia or make a normal sample appear hyperglycemic, potentially leading to inappropriate insulin therapy, according to the Anaesthesia society 1
Fatal neuroglycopenic brain injury can occur within two hours of the onset of hypoglycemia, making accurate glucose monitoring critical, as highlighted by the Anaesthesia society 1

Never use glucose-containing solutions (like 5% dextrose) as insulin diluents or arterial line flush solutions, as they can lead to inaccurate glucose readings and inappropriate insulin dosing, as warned by the Anaesthesia society 1, 2
Avoid storing glucose-containing solutions in clinical areas where they might be mistakenly used as flush solutions, as advised by the Anaesthesia society 2
Be aware that contamination of a blood sample with just a small amount of glucose solution would conceal true hypoglycemia or make a normal sample hyperglycemic, as noted by the Anaesthesia society 1